Below we’ve posted an interview with Hari on his new book, Lost Connections, which is an investigation of the depression industry, although he doesn’t call it that. His work started with his own experience, of being medicated for depression starting as a teenager and only having at best short-term relief. He found it striking that his experience of rising doses with what amounted to relapses was common and was also taking place when the number of people taking anti-depressants and other psychoactive medications was exploding.

As you will see, Hari makes a strong-form argument that the causes of the big increase in reported cases of depression are social, that the modern work environment is particularly hostile to people having a sense of control and purpose that is important to well being. He also contends that the “brain chemistry imbalance” theory of depression was not proven when selective serotonin uptake inhibitors like Prozac were becoming popular and even as of today does not have a solid scientific foundation.

Another angle Hari discusses is the way that advertising induces people to make unhealthy social choices. I wont’t give away the anecdote in his video. But more broadly, advertising is designed to create needs and wants, which means preying on insecurities and desires. Moreover, a great deal of advertising presents people who are “happy” as the result of consuming the product or service on offer. That happiness is seldom contentment or relaxation; instead it is usually giddy or euphoric. Those aren’t sustainable states. They are brief highs. But the message to consumers on a large scale basis is that that is what your life should look like, and if it doesn’t, you must be doing something wrong.

By contrast, a major focus of religions is how to reconcile individuals to the inevitability of suffering and death.

The wee problem is that there is a big gap between the theory of how psychiatry ought to be done and what is actually taking place. My large sample (relatives who’ve suffered from depression, and way too many people I know personally who are taking anti-depressants) is that at least in the US, the pattern conforms to what Hari describes: doctors, including GPs, all too eager to hand out drugs like Prozac and Adderal, with no psychological evaluation whatsoever. From what I can tell, in major US cities, they are seen as productivity enhancers and thus perfectly fine to prescribe casually.

By contrast, one of my former lawyers who is also a biomedical engineer is FDA specialist, and many of the partners in her boutique intellectual property firm are former FDA commissioners with serious medical and/or science backgrounds. She has mentioned repeatedly that while they take Valium casually, to a person they’ve made clear that they would never take an SSRI and have advised her to steer people away from them. So it isn’t just members of the great unwashed public who have reservations.

As Hari points out in an excerpt from his book, one of the problems with talking about SSRIs is that the drug companies have been cherry-picking studies for decades. Not only is the efficacy of SSRIs not so hot (around 50%), it’s not much higher than the placebo rate (30%).

>>The wee problem is that there is a big gap between the theory of how psychiatry ought to be done and what is actually taking place.

True, but isn’t that also true in just about all fields of healthcare?

And for that matter, in education, social work, financial planning and accounting, legal counsel…really any kind of professional service tends to be rushed and poor quality for the average-income and even somewhat-above-average-income person.

I think the fundamental economic issue is how can anyone afford to pay someone of a higher or even similar income to dedicate a significant amount of time to them? Which is an argument for decommodifying all these things and making them government services (and paying the relevant professionals more modestly).

No and that sort of black and white characterization is frankly lazy and disempowering. Basic public health (clean water, washing your hands) are enormously effective. Aspirin, antibiotics, appendectomies, C-sections, rest-ice-elevation-compression for sprains, polio and plenty of other vaccines, work. It used to be that men who went to war and were injured died. Now if the chopper gets to them before they have lost too much blood they live although they may be badly injured. I am sure readers can add to this list. The fact that there are many medical procedures that work very well when dispensed properly is what makes the over-prescription and over-hyping of anti-depressants so disturbing.

You referred specifically to the “theory of how psychiatry ought to be done.”

The theory of how psychiatry ought to be done is labor-intensive and therefore expensive given what psychiatrists are paid.

SSRIs and other psychiatric meds are being jammed into the model you praise, of antibiotics, vaccines, and other cheap, one-off treatments, a model that does not work for mental health.

You can tell people to give up their social media and establish deeper social connections, but to actually achieve those outcomes, you have to pay some real human beings to follow up to make sure they do that, and that costs money.

And the irony is that website comments sections are probably the only thing worse than social media for mental health, and here I am. I think I will take Hari’s advice for a bit.

In fact, you could argue that the medicine now is way too successfull in a way. It can keep people alive even when their quality-of-life is, and will be for a foreseeable future, horrible (and as an extention, making it horrible for their families).

The problem is that we have tools that are becoming more and more effective – but IMO, to a large extent we’re now dedicating more and more of our time making the tools,and making them even more effective, while ignoring that they are just tools, and should server a purpose – other than moar tools more efficiently.

But there are other bad examples in medicine. For instance symptomatic treatment of menopausia with estrogens and cancer risk. Any phisician with a little knowledge on hormone physiology should at least suspect that hormone treatment migth have unpredictable outcomes given the powerful mode of hormone action and their pleiotropic effects. How long did it take to realise the true risks of the prescription? Too long I think.

1. I was in Oz when the research raising concerns re HRT and cancer risk came out, and the Oz doctors (mind you, I doubt HRT is used anywhere near as much as in the US, where the big rationales were reducing osteperosis and heart attack risk, plus vanity, not as much menopause symptoms, since when you go off the HRT you apparently get them anyhow) and they though the concerns were overblown. Even though the increase in cancer risk sounded serious in % terms, it wasn’t in terms of absolute cases. (However, whether or not HRT reduces heart attack risk still seems to be under dispute, some studies show yes and others not).

2. There is a school of thought that the problem isn’t HRT per se but the use of synthetic hormones. And I have heard this from MDs who were not on the “natural” bandwagon.

3. Overweight and obesity are risk factors for postmenopausal cancer. That’s due to higher estrogen levels. HRT started to be used when overweight and obesity rates were going up dramatically in the US and UK. I’ve never seen anyone adjust the samples for these studies for the weight of the women. I would imagine that the incidence of HRT-related cancer would be highest in the women who were overweight.

Even eating a high fat diet and not being overweight leads to higher estrogen levels:

That is a long-winded way of saying none of this is as straightforward as it seems.

Indeed. Oz has explicitly abandoned its old slip, slap, slop campaign against melanoma. Why? Because most Aussies are now highly vitamin D deficient – plot levels by latitude of conditions like MS in countries like Oz and Chile that cover a lot of latitudes – it’s phenomenal – since diet is NOT a factor (from within country studies) it’s clearly sunshine – sun/vitamin D is associated with rates of MS. Trade-offs, it’s always about trade-offs. The new message is “little bits of sun in the morning/late afternoon” with adjustments depending on your skin type. They have finally cottoned on to the fact vitamin D deficiency is an awful awful problem in mental health. And ironically the problem has been known since at least 2005 when I was first lectured on it (see below). But I was always told, it takes 14 years on average for a medical research finding to really make a difference in everyday practice……*sigh*

Yes. it’s very well established that the further you live from the equator the higher your risk of contracting MS. It is nothing to do with country (cultural) factors since countries that span a lot of latitudes (Chile/Aus) see this too. The reason is still not known but they’re 99% sure it must be sunlight related…. the best hypothesis at the moment is how much sunshine your mother exposed you to when you were in the womb

You’ve stumbled into an important battle in pharma. The big cartels are trying to cut off access to bioidentical hormones so patients will be forced onto patented, rent-producing chemical variants. The problem with the pseudo-estrogens and pseudo-progesterones is that they aren’t the exact same thing. Some of these molecules, in fact, have been designed to do other things like interfere with aldosterone metabolism (somebody thought that would be great at fighting acne) and horrendous side effects can result.

As to the problems with estrogen replacement, yes it can cause breast cancer but the mortality data on it is still pretty good. It’s good for memory, the cardiovascular system and bone health.

The two main problems I would check first are obesity (as you point out) and homocysteine levels.

You pretty much nailed the obesity problem – which they never screen for whenever Pharma wants to pump out a study proving estrogen is dangerous. The only thing I would add is that there is a fat/bone axis regulated by vitamin D3. If resources are pouring into fat, your bones are getting weaker. That affects estrogen – and vitamin D3 and one carbon (methyl) metabolism (i.e., homocysteine).

Homocysteine is an independent risk factor for Alzheimer’s and cardiovascular disease. It indicates a deficiency along the methylcobalamin/folate/SAM-e metabolic chain. These methyl groups regulate an awful lot, even genetic transcription, and when we have problems with them it’s generally due to deficiency and the results pop up in conditions like Alzheimer’s, stroke or colon cancer. To make a long story short, when homocysteine is high, eNOS doesn’t produce artery-relaxing nitric oxide (NO). Instead it produces the highly oxidizing radical, OONO-.

Estrogen stimulates eNOS, which is why it’s so healthy for the heart. Women are protected against cardiovascular disease up until they hit menopause and those estrogen levels drop. But add estrogen to an environment with high homocysteine and you should get more oxidizing OONO- in arteries, not NO. This could account for a significant proportion of adverse events associated with estrogen replacement. You might need to address the methyl deficiency first before you ever toss estrogen back into the mix. I think the mortality numbers of estrogen replacement would look even better if they addressed this.

We’ve known about this for over a decade but nobody tests for this or mentions it in the literature. It’s crazy.

Anti-depressants, antibiotics, and opiates all appear to have been over-prescribed by the general medical practitioners leading to significant society-wide health issues that manifest themselves in different ways. Somehow, there does not appear to be an effective feedback loop to reduce over-prescription and improve the evidence-based, instead of marketing-based, guidance.

So we are going to extraordinary lengths to save soldiers on battlefields and not expending anything close to the same resources at home. This explains why we are seeing issues with things like rising maternity deaths etc.

I was diagnosed as depressed and given zoloft at around 47 and was told I would need to be on it for the rest of my life. I took it but disagreed that I needed it forever. I was single, with a 4 year old with issues (aspergers it turned out), new job, moved twice by myself, took bar exam and passed. Also hated job and think was pre menopausal. I quit my job (without having a new one–but knew that even with zoloft wouldn’t get better with that job). I went for a routine female exam and the gyn when he noticed that I was on zoloft asked if it had changed my life and made everything better. I answered no, but quitting my job had done so. I weaned myself off of zoloft, moved again and found new job(s). My job(s) then had nothing to do with law and banking and pay a lot less and had much less “prestige” People have often questioned my career changes but I haven’t needed zoloft. I know of too many people who medicate themselves just to function and go to work. My daughter’s doctors also often tried to medicate her. She has refused as an adult (without asking my opinion or my giving her input).

I first became aware of the astonishing lack of evidence for the “brain chemistry” theory of how anti-depressants worked from a long 2011 review-essay by Marcia Angell in the New York Review of Books. It’s fairly devastating on the how this industry, to call it something, came about, and might be a useful complement to the above. It’s in two parts at:

I have no doubt that plenty of SSRI prescription is the triumph of the profitable over the medical.

What’s interesting though has been the reconceptualization of depression as inflammatory over the last decade. Even if you subscribe to the brain chemistry imbalance notion, that now chucks the issue from psychiatry into immunology (and neither discipline seems happy with it).

There are two tryptophan pathways of interest here. One goes down the serotonin/melatonin pathway, which means good sleep and normal neurogenesis/mood/memory.

However when infection activates interferon-gamma, that triggers IDO which sends tryptophan down a different pathway that eventually winds up at niacin with all manner of neurotoxic metabolites in the middle like kynurenine, which is elevated in schizophrenia and Alzheimer’s – and is associated with the depressive symptoms caused by interferon therapies. Physical exercise and antiepileptic ketogenic diets should lower it via KAT enzymes. A number of herbs inhibit IDO too (but I’m writing all this from memory).

All an SSRI will do is leave more serotonin hanging around the 5-HT receptors. That’s fine but You’re still going to get hit by those neurotoxic metabolites.

I’m not sure that the “more seratonin” is true for all that long. The body is a great adaptation machine and it seems like a lot of people have their systems compensate for what the meds are doing. My uncle, who was diagnosed with depression, must have been put on every drug and drug combo there every was. Not unlike Hari, he had one of two results: either the drugs did nothing, or he’d get six weeks to max six months of relief and then be back to where he was. I know of way too many people first and second hand who found that SSRIs helped for a while then stopped helping (I do know of one long-term Zoloft user who is satisfied, but he is the only one in my circle in that category). My uncle was so desperate that he got electroshock.

Chronic inflammation is strongly linked to major depression so depression is often just a symptom of something else going on. You’re right. An SSRI really isn’t going to resolve that kind of inflammation on its own, as one of these recent publications shows.

This is correlation at best. You don’t have causation. There could well be a factor that leads to both effects.

There is strong evidence that exercise (and it does not have to be that intense) is an effective remedy for mild depression. Who knows why. Endorphins? Better general health?

The reason I am expressing doubts is I have seen way too many cases over the years about new theories attempting to explain various ailments and after initial enthusiasm, upon more work being done, the new theory was found to have less explanatory power than initially assumed or was even discredited. “Inflammation” looks an awful lot like that.

Beta-hydroxybutyrate (BHB) can also induce KATs. BHB is elevated by intermittent fasting, ketogenic diets and taking certain ketone supplements. This approach has improved epilepsy and, more recently, defects in the brain metabolism of Alzheimer’s patients (in fact the data on MCT oil is at least ten years old at this point).

So, no. It’s not correlation. It’s just research the average doctor doesn’t want to read and the average Pharma company doesn’t want your doctor reading because it would adversely affect profits. MCT oil, exercise, alpha ketoglutarate and fasting are all free or in the public domain.

Again, you just proved what I was saying and you are mis-reporting on the literature. The first article in your earlier comment described the inflammation as a result of an immune deficiency, and depicted the CVDand the inflammation as effects of that cause. (https://www.ncbi.nlm.nih.gov/m/pubmed/29321801/)

Nowhere in the paper does it mention “immune deficiency.” In fact, it cites several overactive immune responses:

“inflammatory cytokines [e.g., interleukin-6 (IL-6) in CHD] can independently predict cardiovascular mortality in healthy individuals and in patients with CVD and CHF. Immune activation also has a link with depression as well as with *increased numbers of circulating leucocytes* and *proinflammatory* cytokines such as IL-1, IL-2 and IL-6.”

None of this points to an immune deficiency but rather overactivation.

There are several layers of the immune system and it is possible that someone could catch a viral infection because of low innate immunity and then the latent infection could trigger sickness behavior by overactivating other arms of the immune system – i.e. a deficiency in the first response could lead to excess in later phases. A deficiency in resolution phase could also contribute by interrupting the resolution of the stress.

In addition to interferon therapy inducing depression in patients who receive it, interferon-gamma levels are elevated in women with depression [PMID 28670290] – and IFN-gamma is a well known inducer of IDO. In any event, the effects of IDO are context-dependent. In moderate doses, IDO degrades tryptophan and prevents T-cells from attacking; it’s actually anti-inflammatory in this regard. Mammals can’t protect a fetus from the immune system and maintain a pregancy without IDO. For this reason a number of cancers overexpress IDO and herbs like rosemary often contain chemicals that inhibit IDO (presumably to discourage consumption by herbivores).

If you show up in a doctor’s office with unresolvable depression, you might have one big factor or fifteen little ones. I’m not prejudging any case. I’m simply pointing to possible contributors.

I agree my writing was imprecise, but “immune deficiency” as in deficiency of how the system operates, meaning defect or “abnormality” which is the term the article used.

More important, it was also explicit in stating that the direction of causality is not clear, while you made repeated strong form assertions that inflammation causes depression. This is from the abstract:

The findings show that major depression and CVD patients have greater immune abnormalities, which may increase depressive symptoms and cardiovascular pathological changes, and that there may be a bidirectional relationship, therefore more prospective studies are needed to draw conclusions.

I have had it with you continuing to overstate study findings. This was a MOUSE study where they observed what the researchers deemed to be depression like after injecting them. Moreover, most studies are up front about the sample size. That study buried it. I don’t have time to go digging through all the data, but looking at the scatter charts, the sample looks to be well below the ~100 sample/~100 control that my scientist colleagues who read medical studies for big bucks to determine what to recommend to professional athletes as reliable or not (and that isn’t the only thing they look for, they have serious statistical chops, but they regard any finding on small samples as “not proven”).

Moreover, you ought to know that there is tremendous pressure on researchers to produce findings and torture data to yield that, another reason to look harder at studies than you appear to. You have been pushing “chronic inflammation” which is a recent health fad, and exhibit confirmation bias in finding studies to support it. I’m not saying that inflammation doesn’t play a role, but even the studies you tout are regularly vastly more equivocal about its role (is it a cause or effect) than you are. And in general, high degrees of confidence about anything in medicine are a huge red flag. It is hugely costly to do anything resembling adequate studies, and your assertions are way out of line with the current state of knowledge.

I am not tolerant of people who overstate findings. You are doing it consistently even after being called out. This is not on. Go start your own blog. You are not welcome here.

ECT- electroconvulsive shock therapy is used today. However, its considered therapy of last resort for patients with severe symptoms. Patients are sedated unlike the early days of experimentation, and they don’t experience convulsions and pain or remember the procedure. ECT is effective for some patients with severe depression recalibrating the brain waves.

I know of way too many people first and second hand who found that SSRIs helped for a while then stopped helping

From a totally scientific sample of One – Me – I would say that That is exactly the purpose of the SSRI’s. The medication gives a break, a period of relative peace, where one can deal with what it is that the poor old brain doesn’t like to do and shuts itself down over (It really does, new nerve cells are created in the hollow areas of the brain, float around and attach themselves where needed. In a depressed brain, the cells are malformed and do not stick. Depressed people suffer some brain injury, which also cause depression)!

Just taking the medication and not changing anything else will lead exactly nowhere. The body will in time learn how to burn the medication more effectively and then the feelings of depression is back.

In my case, depression was a notice that I thoroughly needed to change my life, my approach to life and my values also. The SSRI’s only gave the quietness – they shut down emotions, basically, good and bad alike – to be able to bother about going to the psychiatrist, exercising, taking time to relax and basically treat myself more as a friend (I used to be quite hard on myself).

The artickle is spot on that the ceaseless comparing oneself with other people and all those things “you must have and do to be successful and liked (but cannot have because you are too poor)” pushed upon us by “social media” and ceaseless advertising, are extremely toxic for the brain; “society” is not helping here. .

Long-term Depression is class thing, I think.

Many of the resourceful people can manage to get proper help, they can afford to adjust lifestyles and will get cured – in the sense that they can manage the disease, because in my experience it never goes totally away. People with few resources gets “the algorithm” and the medication only, they will stay depressed.

On the other hand, values are perhaps changing to something more life-furthering. At least some people I know, who used to be quite materialistic, seem to have realised that even if one cannot afford the full range of “Le Cruset” cookware, it is not The End of Life – because one can cook equally well for ones friends on used cast-iron cookware and it is even OK to talk about how one got it for 40 Euro (Or – Maybe this is only OK if one has resources and therefore have nothing to prove?).

I read that Faber-Castell is occasionally running out of colours. Colouring books are a big hit as are paper calendars and organisers. I see many “normal”, people in the thrift shops. Way too many people are out in nature. Analogue is “in”. Still time to save the planet.

PSS –
Any decent conspiracist would think that “Social Media” is USA’s new way, after MTV, to rub out future competition by destroying the brains of children early, much of the research behind driving addictiveness and brain washing inside those apps comes from MIL-SEC complex money after all :).

Just to be clear, despite the doubts I raise, I am not opposed to SSRIs. I am opposed to what looks like massive overprescription of them. They do not appear to be used primarily for short term relief, based alone on the fact that 13% of Americans take antidepressants, and that the overwhelming majority are long-term users:

Many people who took antidepressants, which are used to treat depression as well as anxiety, also reported using them longterm: 68% of people ages 12 and up said they had been taking their antidepressant for two years or more. A quarter of people who took antidepressants reported taking them for 10 years or more.

time.com/4900248/antidepressants-depression-more-common/

And let us not forget that some of that remaining 32% will include people who started recently and will become long term users. And some will be people who tried them and stopped either because they didn’t do much for them, or stopped working, or they didn’t like the side effects (weight gain and loss of sex drive).

From what I can tell, SSRIs have low efficacy: about 50% who try them seem to benefit, when the placebo rate is ~30%. That does not mean that there aren’t users who are not getting real benefits. It’s just that there is a lot of cause for pause that seems seriously at odds with how frequently they are prescribed.

Wade, so glad there is someone else who sees the importance of IDO. Stress alone will increase IDO activity and result in less serotonin, so no need for an infection.

I agree that taking SSRI’s do nothing, but is inhibiting IDO the way to go? Or is this kyneurnic activity meant to spring us into action? If we inhibit IDO and keep the stress what have we really accomplished? This is what Hari is talking about.

Indoleamine 2,3-dioxygenase.
When you eat foods like Turkey that have Tryptophan it gets metabolized in one of two ways. See the image here. The pathway going down turns it into Serotonin and Melatonin. The pathway going right uses IDO to transform it into possible carcinogens.

Low serum levels of vitamin D are associated with clinically significant symptoms of depression in otherwise healthy individuals, new research shows.

Making a series of assessments of healthy women during a 1-month period, investigators found that more than one third of participants had depressive symptoms, that almost half had vitamin D insufficiency, and that depressive symptoms were predicted by vitamin D levels.

Noting that vitamin D supplementation is a low-cost, simple, and low-risk intervention, they add: “Given the lifespan health risks associated with insufficiency, supplementation is warranted whether or not the modest role of vitamin D in depression observed here generalizes more broadly.”

…..After taking into account season, body mass index, race/ethnicity, diet, exercise, and time outside, the researchers found that lower vitamin D3 levels across the study period predicted clinically significant depressive symptoms. The only other factor to predict depressive symptoms was use of antidepressants.

vitamin d supplements? or an ssri? how long ago did we completely abandon ‘first, do no harm’?

I forgot to mention in the post: one of the pet peeves of an endocrinologist I know is that women are pretty much never tested for low testosterone. He says 1/3 of the women on antidepressants are actually suffering from low testosterone and getting that treated would clear up the depression.

Interesting. I didn’t know the testosterone connection but it wouldn’t surprise me – my sister has similar profile of mental health issues to me and vitamin D deficiency was identified as a major issue for her too…..but I don’t think she has had testosterone checked – though it might be because she has had womb issues and ovaries removed, leading to doctors doing their usual thing of “thinking only inside the box concerning the immediate issue”…..maybe tests of testosterone would clear up a LOT of issues.

Years ago, circa 1990, I was married to a gynecologist, and it was not unusual for her to prescribe a little testosterone for women. I never had the impression she was unusual in that regard.

Re Vit D “predicting” depression, this is predicting in the statistical correlation sense, which can be turned around. One might note, for example, that depression predicts excessive staying inside, out of the sun. I’m not denigrating Vit D deficiency (like my own), but encouraging care in interpreting headlines.

Re SSRIs, it’s well known that one often has to try two or three SSRIs to find a helpful one (for an actual depressed person, not an understimulated happiness seeker) and that the body typically adapts to an SSRI rendering it gradually ineffective over time. The latter leads to gradual dose increases until the maximum is reached, at which time doctor (preferably an actual psychiatrist) and patient begin the search all over for a new one. But neither that nor their overprescription by clueless GPs/PCPs is to say they are useless. They’re just difficult, and there’s a baby/bathwater aspect to these tiresome arguments about them.

Androgens have a tendency to suppress the immune system whereas estrogens can enhance the innate system of sensing pathogens (TLRs). This shows up in gender statistics of infectious disease and sepsis survival, as well as autoimmunity. Androgens also have deep effects in dopamine networks and can stimulate endorphin levels almost like a drug – one of the reasons men abusing steroids find it so hard to quit. Then again, vitamin D3 also stimulates endorphins which can explain how people can get addicted to tanning beds.

If this is how androgens are working, a prebiotic fiber like inulin would also stimulate endorphin production via GLP-1 production without risking ovarian cysts or thinking about sex all day. In fact, a low fiber diet might produce symptoms of depression in the first place. Estrogen itself has complex effects in the gut and is itself metabolized back and forth to androgens. If the gut’s affected, one place this would show up is in magnesium deficiency – which produces plenty of neuroinflammation via substance P.

I suspect staring at screens all day is bad for people as well. But for many it’s the only way to earn a living (it’s not about what we do on our leisure time as that’s at best a few hours a day). Perhaps even awful office lighting plays a role.

In short, vitamin D3 deficiency will directly cause depression. D3 directly affects dopamine production in myraid ways. It stimulates innate antiviral and antibacterial immunity (e.g., cathelicidin – which may antagonize amyloid sheets, by the way). This aspect of D3 prevents the kind of infection that would lead to immune overactivation and subsequent depression in the first place. D3 also has numerous affects on IDO, arylhydrocarbons, the toll-like system, etc, etc. Just thinking about the scope makes my head hurt.

One interesting factor is that IDO-derived kynurenine itself activates the arylhydrocarbon receptor (the AhR is sometimes also activated by infections directly – see CMV). This activation can break down vitamin D3.

Adam Curtis last doco ‘HYPERNORMALISATION’, the girl in the town Wenatchee where blackrock has it servers – paraphrasing: I feel better about my self, I’m doing better, were all doing better, its kinda like everyone is brainwashing themselves to be happy.

I think that there several problems with our treatment of mental illness.

The first is that people, and their brains, are beyond complex. It’s not easy, sometimes impossible, to find cause(s) or the cure(s) for an individual.

Second is that the modern Western society does a wonderful job in creating depression in those who normally would not be depressed and strengthen those who would still be depressed even in a good mental environment.

And last, our current “healthcare” system almost requires a simple, and profitable, approach to mental illness preferably having it managed not cured.

I would compare mental illness to cancer. There has always been cancer. Sometimes it’s genetic, sometimes environment, and sometimes just bad luck or chance. The current environment we live in encourages cancer, but plenty. Treating cancer is often very difficult because there are multiple causes, multiple treatments, and the damn disease often develops resistance to a particular drug. If a cancer sometimes takes surgery, chemo, and radiation to get rid of it (and we know it’s just uncontrolled cell growth) should not mental illness be more difficult when we cannot agree on what it is?

Grounding, in the electrical sense.
Walk barefoot, on the dirt, thereby grounding your body/mind. Do it often.
We walk on rubber soled shoes, insulators, breaking our connection with the earth.
I walk barefoot 90% of every day; but then I live in the tropics.
Wacko? Not if you’re a sentient being who understands earth body connections.
Where do you think the phrase “grounded in reality” came from?

Thanks for drawing attention to this. BIG bug-bear of mine for both personal and professional reasons. I broadly agree with Hari – and psychiatrists in single payer systems (who don’t coin it in so much per session) tend, IMO, to be more honest – that psychiatry, when it comes to medication (for depression and anxiety anyway), is largely a waste of time and money. There are a multitude of examples. Diminishing returns set in from the get go: MAOIs (first generation – 1960s) remain the most effective anti-depressants (working on all three key neurotransmitters) and, together with some tricyclics (the 2nd generation) are the ONLY drugs that actually start working according to when the psychopharmacological models predict (i.e. within about 4 days). The accusation of “Bait-and-switch” might be thrown at all successive anti-depressants since the model they used to show efficacy clearly isn’t the model they work by (if at all – if they worked how they SAID they should work, they should kick in at around the 4 day point – they don’t and we’re told “wait up to 4 weeks” WTF?). A UK therapist with similar values/knowledge to me told me “there’ve been only around 4 worthwhile drugs in psychiatry invented in the last 30 years – none has been an antidepressant or anti-anxiety drug – they’ve all been in slightly more exotic areas like mood stability”.

Let me reproduce a rather inspired criticism I heard of SSRIs/SNRIs once. Ethics demands that any new drug in either of these classes, in the RCT, to tell patients they may experience side effects like weight gain (primarily women) or erectile dysfunction (men). If you’re a trial participant and suddenly experience one of these side effects then blinding is effectively broken – you *know* you’re in the treatment, not placebo group. Then you get phenomena like the Hawthorne effect, which makes the effectiveness of the intervention appear higher than it would otherwise be in a genuinely blinded trial. In fact I’ve heard it said (repeatedly) that if you net out “Hawthorne effects that many clinicians would consider reasonable” then all the recent anti-depressants are just placebos.

Vitamin D has been mentioned. I recently started seeing a much more inspired therapist who instantly ordered Vitamin D blood tests. I am so vitamin D deficient it’s phenomenal – but I saw a presentation around 2005 from a visionary guy who told my then dept (dominated by epidemiologists who were absolutely vile to him) that evolution has not kept up – anyone living in the UK is likely vitamin D deficient by November and doesn’t get back into the typical “reference range” until well into April. It’s even worse for non-white people (whose skin is less able to convert sunlight into vitamin D). Furthermore, NO foods will give you enough vitamin D (and ironically the ones that give you the most are the “bad” foods like lard etc). I’m pretty sure I was never vitamin D deficient in the past – I lived in Sydney for 5 years, took two sunshine holidays (June and December) a year before that. And interestingly even Aussie public health warnings have changed from the “sun is uniformly bad” message to “get little bits as you’re all vitamin D deficient”. I’ll conclude with a bit of a trope….”it’s neoliberalism, stupid”. We’ve lost control of our lives and factors that previously would not have been enough to push us “over the edge” are now doing so at a phenomenal rate. Sad. Very very sad.

If you are going to take VitD supplements, you might like to know of a tip I was given by a medic, that the body absorbs oral VitD much better if taken with a little fat, say butter, cheese. It does not have to be large quantities, just a small piece.

@Katsue, January 15, 2018 at 8:16 am – Drive-by insults are not appreciated here and are, in fact, a violation of the Comment Policies. If you’re going to make claims like that, you need to provide documentation and links to relevant resources.

The link is in the very article above. The link for the text “Some medical professionals have objected strenuously to Hari’s book.” There is an argument to be made there about Hari’s reputation. However it is still ad hominem as far as the general argument about depression treatment. He can be a plagarist and still be right.

This is an ad hominem attack and it is an invalid form of argumentation as well as against site Policies. By your logic, the Bush Administration, which lied about WMD in Iraq, should not have been believed when it admitted that global warming was anthropogenic. Moreover, Hari is citing independent evidence, and as others have pointed out (see this comment above) highly regarded authorities have already backed the key points in his thesis.

Worse, you are the one who is fabricating. Hari was accused of plagiarism. That does not mean the work was inaccurate, it means he didn’t give credit to the work of other writers that he lifted. In fact, if the Guardian article is accurate, the sort of plagiarism he is accused of (taking quotes from people that were made in other stories and not indicating that they appeared in another article) happens all the time in books and the press in the US. NC’s work is ripped off all the time by the MSM in more serious ways and no one at these papers thinks they did anything wrong (we even got in an argument with a Reuters reporter who owed us credit who got pissy with us and refused to toss us what should have been an obligatory link). He also sock puppeted himself, which is tacky but not a hanging crime.

That does not mean the information he presented was inaccurate, which is what you are insinuating.

I am not making any form of argumentation. I have no expertise in relation to mental health, and I don’t feel that I have anything to contribute to the debate on the substantive issue.

Nor am I insinuating anything. What I said is what I meant. He has earned a reputation for professional dishonesty, and people should be cautious when evaluating his work, just as one should be cautious when evaluating the statements of the CIA or, for that matter, the Bush Administration. It doesn’t mean that he’s wrong, or that he’s lying – it means he can’t be relied upon.

I love what Hari is saying, but I am also frustrated because he continues this “either/or” argument on the nature/nurture causes of depression. It is not nature OR nurture, it is nature AND nurture.

Just like there are genes that make some people more likely they will get more sunburn if exposed to very little sun, there are people who will get more depressed if they have little social contact. Our genetics determine our sensitivity to different environmental triggers. This explains why they find depression runs in families (making it most certainly a brain chemical issue) but will also explain the growing rate of depression (more people suffering more social isolation). Genes do not make enzymes that are on or off, they have make enzymes with varying rates of reaction.

This is why raising serotonin works, but doesn’t. SSRI’s treat a symptom, not a disorder. The disorder is the mismatch between your genetics and your environment. The cure is to stop trying to force yourself to live in the monoculture that capitalism has created. Taking SSRI’s is like stabbing your self with an epi-pen just so you can keep on eating peanuts.

This is true for more than depression, but Bipolar and Schizophrenia as well (and heart disease and cancer, etc). I know because I express the symptoms of Schizoeffective Bipolar at times, yet I now can be stable for years at a time. I have found all of the environmental and genetic variables that trigger my symptoms. Stress is the biggest trigger, but I have several environmental sensitivities.

So you see, I cured my disabling mood disorder. Cured it. And what I mean by “cured” is that I fully understand what triggers my symtoms. I was on 5 meds at one point in my life, and in the psychiatric hospital several times. I am now on zero medications. Yet the response I get from my doctors and my family? “Well, I am glad that worked for you” which is code for “you are delusional”. Ugh. People do not believe me because they are so brain washed that it cannot be cured, because they think that it is ONLY a chemical imbalance that cannot be changed by environmental factors.

Mood disorders are more akin to allergic reactions and all the PDOCs want to do is give us antihistamines and send us on out way. And that is because that is all they know. The distance between research and practice is years and it does not help to have Pharma doing everything in its power to keep Docs believing that SSRI’s cure depression instead of what they really do; hide it. SSRIs hide depression. It was not till I faced my symptoms and listened to them that I was able to cure myself.

What I did was expensive. It meant I had to leave a high paying job and going on disability, study like hell, suffer experimenting on myself, and be even more socially isolated because people thought there was no credibility to what I was doing. But what I found was that the cure is simple and free and can be applied to anyone; live like your genes, not like the culture.

Thank you so much for posting this article because I believe to change economics we are going to need a more integrative, expansive view of the subtle genetic variability of humanity.

Thank you for the insights – not a million miles from my own. One thing you say that accords with Hari but which many people simply (and unfortunately) can’t do:

What I did was expensive. It meant I had to leave a high paying job and going on disability, study like hell, suffer experimenting on myself

I’ve had the good fortune to do a lot of this experimenting whilst earning…..but I know full well I am a very special case. Most people can’t do what I did. Neoliberalism makes things even worse – “jumping off the career ladder” means you’ll probably never get back onto it. And (to address another poster above) yes we know Hari has been guilty of egregious crimes in terms of reporting…..but he’s not covering it up, indeed is giving us “as much information as he can” regarding the reactions to his crimes – kudos. Now, of course, there is an argument that a lot of insiders at places like the Guardian will always have their “way back in” due to greased palms, etc. And yes, I believe Hari got a way back in that us 99% wouldn’t ever have got. But that doesn’t necessarily invalidate his insights.

Thank you so much for posting this article because I believe to change economics we are going to need a more integrative, expansive view of the subtle genetic variability of humanity.

It’s funny, I was just working with a high school kid, tutoring them in their biology homework in preparation for a test.

Genetic variably is not even remotely subtle. The differences need to be robust for the purposes of natural selection. I agree with you on taking the expansive view, but take the opposite view: we should view any genetic differences are necessarily robust, rather than subtle. They should be self evident if we aren’t kidding ourselves into thinking humans are robots.

cocomaan, I agree. I was thinking in my head that one can have many subtle genetic changes that can have the same effect as one large one so we need to integrate all of these genes together. Researchers will often say that a SNP in a gene has little effect on enzyme function and so disregard it without looking at how it affects other genes which may express slow enzymes as well.

Also, what is very frustrating in genetic research, is that since rare gene SNPs are hard to research, they do not research them. DOH!

This observation is important, because Yves Smith is describing U.S. medical care and its scope: “in the US, the pattern conforms to what Hari describes: doctors, including GPs, all too eager to hand out drugs like Prozac and Adderal, with no psychological evaluation whatsoever. From what I can tell, in major US cities, they are seen as productivity enhancers and thus perfectly fine to prescribe casually.”

U.S. medicine is based on prescriptions. One symptom is a Walgreen’s and a CVS on every corner, now with grocery departments and Christmas decorations. I sometimes wonder if the prescription model of medicine is also a way of controlling the patients’ lives. The insurance company doles out the drugs. The doctor classifies the condition as chronic–so many appointments are required to take care of it.

As several commenters have pointed out, “traditional” psychiatry, the talking cure, which evidently goes back to the ancient Greeks, takes up too much time. It can’t be taylorized well. If you start reading C.G. Jung or James Hillman, you will also find a completely different idea of what causes depression. In many cases, they’d say that depression is a normal reaction. The question for them was metaphorical rather than chemical: The cure was to help the patient function. And, sometimes, they would put psychiatric treatment on a hiatus for the sake of the patient, too.

But those days are gone. We wouldn’t want someone with depression to have an advisor committed to understanding sources and changing the course of the depression. Compounding pills is so much cheaper.

Well most therapists aren’t Jungians either and so they also view depression as something abnormal to be treated as quickly as possible with CBT etc..

But despite it’s low cure rate traditional therapy was never widely available to the masses or focused on their (economic) problems anyway, it’s most effective for those with a certain degree of privilege. Books however we can all access.

Interesting comment about the role of religion. I submit that the continuing commodification of religion in the U.S. is now a source of depression.

The great religions have a comprehensive view of suffering, life, and death: You can find many strains within Sufi Islam, Roman Catholicism, Buddhism, and Orthodox Christianity. I’m not so sure about “American religion,” which consists of large number of The Saved and a large number of The Spiritual but Not Religious (whatever that means, aside from an assertion of perfection). When you are saved and perfected, and you still feel uneasy in the world, what do you do?

The great philosophies were even better at giving purpose to life. This is central to Buddhism, which some don’t even consider a religion–and Theravada Buddhism still tends to be non-theistic. I just finished re-reading On the Nature of Things (in a sprightly, witty new translation by A.E. Stallings). Lucretius can guide us. Epicurus, his source of philosophical ideas, can guide us.

But the spirituality of Oprah or the general confusion among evangelicals these days? More depressing than life-affirming.

Really liked this interview and agreed with a lot of the points made. Medicine seems to be great and evolving in certain circumstances and not in others. Infectious diseases, accident recoveries, surgical interventions, joint replacements – these are some of the areas where medicine/medical practitioners seem to be very effective. But for illnesses-diseases such as cancer and depression (& other mental illnesses), I don’t believe the medical industry has been successful at truly understanding the basic underlying causes and figuring out the best solutions. I totally agree with the idea of “control” as integral to one’s sense of satisfaction/happiness/contentment with the world.

has anyone here read the books of Roslyn Carter? I have not, so am curious.

in any case, I think that the science of mental health is something like 50 years behind physical health. Also I think that a great deal of thyroid disease is misdiagnosed as depression. A great deal of sleeping disorders are misdiagnosed as depression. A great deal of lead poisoning is misdiagnosed as ADHD.

My personal experience: I am a 68 year old man. I have had severe depression since I was twelve years old. I started antidepressants 25 years ago. They have given me relief and saved me from a lot of suffering. I have stopped them as a trial numerous times but my depression always comes back. I am very grateful to have them.

I’m close to your age and have suffered from depression as well. Have you tried any of the strategies people have mentioned here, diet, supplements, exercise, etc? In my late 40s I was put on Paxil for a few months and it was horrible, and the withdrawal was horrible as well. I’ve been on a small dose of Bruproprion for several years and it seems to help although I’m about ready to try giving it up in the summer months. I suffer in the winter months from the lack of sunlight. We are creatures who evolved in the tropics.

Then again, with our current western culture, it’s almost like if you aren’t depressed, you aren’t paying attention…

Yes I practice all the recommended strategies, but I still need medication. I have tried most of the medication and they have all seem to work but all have had objectionable side effects. However the side effects pale in comparison to the suffering that depression brings. For the last two years I have been using a new drug called Trintellix (vortioxetine.) It is the first one for which I’ve had no noticeable side effects.

“By contrast, a major focus of religions is how to reconcile individuals to the inevitability of suffering and death.”

Like how you just snuck that one in there ;)

That is the million dollar point that ad agencies, medical industry, and just about everyone you meet is running from. Once you stop trying to run from death, turn around and meet him (probably a he right?) head on, you’ll find that depression and anxiety will be expunged – generally after a “psychotic” (sane) breakdown and drastic restructuring of your life, relationships, values.

I hate the title Why Pretty Much Everything You Know About Depression Is Wrong, and it’s attack on the straw man of ‘a chemical imbalance in the brain.’

It’s so damn condescending. I researched my own condition, and anybody who would do the same will know that the ‘chemical imbalance’ idea is a shorthand used to try to remove the stigma associated with psychiatry, and not a medical description of the mechanism of disease. Anybody who as any kind of interest in what current research is saying knows that while SSRIs do inhibit the reuptake of serotonin, it is not ‘higher serotonin levels in the brain’ that makes the treatment effective. Their mechanism of action is not really clear, but it seems that improved neurogenesis is likely involved.

The other straw man among the commentariat is ‘treating the symptoms but not the cause’. What else do you want to treat? A symptom of a broken bone is a floppy limb. Is putting a splint on it just treating the symptom, or is it treating the cause? Both, obviously! If you can make a man’s madness go away by giving him a pill, you give him the means to remove him from his maddening circumstances.

Yes, the stress in our society creates depression. Obviously. Duh.

If Johann Hari was surprised that he was influenced and mis-informed by advertising, he shouldn’t project his ignorance on me.

I no longer tell people I have a “chemical imbalance” since I know it is not that simple. I tell them I have environmental sensitivities, which is a more medical description of the disorder. Note as well that I call it a disorder and not a disease, because they are not diseases.

And yes, if serotonin was the sole cause of depression they would work for everyone and work right away. The fact they take up to a month to work some think points to low dopamine being more relevant to depression.

SSRI’s made me immediately manic/OCD without getting rid of my depression. That gave me a lot of valuable information in helping cure myself and it is how doctors should practice as well.

Yea it is kind of a strawman, but *if* the neurogenesis theory is correct it seems antidepressants would hardly be the *only* way to achieve that (what about meditation, what about learning something entirely new etc.) rather than just one means to do so.

” If you can make a man’s madness go away by giving him a pill, you give him the means to remove him from his maddening circumstances. ”

necessary perhaps but NOT SUFFICIENT. It is true that in a better psychological state a person might see a way out of their circumstances that they didn’t before. But then again they might not, as the circumstances themselves may not be changeable. That seems perfectly obvious to me.

The broken bone example does not apply. I happen to be afflicted with chronic pain (which is depressing) from peripheral neuropathy. Treating the symptoms but not the cause in this kind of case means pain reduction efforts (usually not very effective) but no effort to provide treatment that would effect a cure and a return to health. It seems that none of the medical people I have consulted know the cause of the peripheral neuropathy, so I can’t hold their grasping at symptoms against them (but not saying they don’t know the cause, or worse, pretending that they do, I do hold against them as not caring). At any rate, my experience with the medical industry is that it is a “medieval art” focused on trying to mitigate symptoms (with magical concoctions and incantations) and only in special cases (like broken bones, infections, etc.) addressing causes, but still with the intent of dealing with symptoms (as the broken bone example emphasizes) rather than making health the purpose of the medical interaction.

I’m not a scientist, psychiatrist, or other health care professional, nor do I play one on TV. However, like Croatoan and others, I have cured myself of both depression and PTSD without the use of commercial medications or psychoanalysis. My daughter, who was diagnosed as bipolar at the age of 11 and stopped taking the lithium prescribed for her condition a year later because she hated the side effects, is now cured of that condition likewise without using prescription medications or the services of a counselor.

In my 70 years, I have both experienced and observed many, many people who are diagnosed as clinically depressed or otherwise afflicted. I have also watched the number of “mental health” conditions increase steadily as pharmaceutical companies discover new medications that can be applied to those “conditions.” The last straw was the literal involvement of the pharmaceutical industry in the development of the DSM-5.

It’s my belief that anyone suffering from depression, PTSD, or any other diagnosed similar condition should be asked to initial questions: When did you begin feeling this way? and What are you angry about?.

We live in a cultural that rejects the acceptability of anger—even rage—as a response. We are taught from earliest childhood that we must control it, that it’s bad (even evil), and that anyone who gets angry over anything has something wrong with them ethically, morally, and/or emotionally. To put it another way, we are taught the only acceptable target for our anger, other than things we can’t do anything about like massacres and so on, is ourselves for being angry.

That, in the end, was what cured both my “conditions” and my daughter’s. We recognized that we had a seething cancer of anger deeply buried in our minds. Anger we had never been permitted to express, and when we did express it were told our anger wasn’t acceptable as a response.

Considered in light of the current economic, social and political situation in this culture, I’m not at all surprised to hear that 20% of the population is being drugged into submission. We have more to be angered and outraged about than we’ve had for a very long time, and we are also being told we have no right to be angry about it because there are people in other countries who are fighting to have what we have. It’s the new version of the “starving children in China” we Boomers heard every time someone tried to cram a hated vegetable down our throats.

I haven’t read Mr. Hari’s book, but what I heard definitely resonated with my own experience. I suspect it would do so with my daughter’s as well. My cure was rejecting the lie that I had no right to be angry and learning that anger is a valuable tool for making necessary corrections. Like any tool, it has to be used properly, but its expression is vital to our balance as human beings.

I want to add that I think American Buddhism, or “mindfulness”, is doing a disservice to humanity by trying to make us invulnerable to things we should recognize as threatening so we can change them. Mindfulness works like Prozac works; not for long. Enlightenment is supposed to free us of our attachment to our desires so we can act in a more kind and liberated way. Mindfulness wants to free us from the stress created by our desires so we can keep desireing the same bad things.

I swear if I hear one more of the teachers speak in a hushed tone to me I will scan at them at the top of my lungs.

Then there’s the flip-side, media induced fear and anxiety. My greatest concern is what our brains are spoon-fed through visual and auditory media. Since we are biologic beings, the brain’s interpretation of fantasy or real violence plus social media propaganda- impacts the emotional center which is the primitive part of the brain- the amygdala. The amygdala is triggered to react even though the prefrontal cortex intellectually distinguishes between imagined and genuine violence. Yet, exposure to any forms of aggression sets off the amygdala’s natural reaction, raising the heart rate to fight or flight, anger, etc.. and in-turn, brain chemicals release inducing fear and anxiety, all key components to depression. The emotional brain doesn’t forget but interprets and files every real and imagined experience. Neuro-plasticity informs and reorganizes brain patterns and functions. Its always learning, adapting and forming new connections. Exposure to a steady diet of hollywood violence along with government’s dismantling of social programs and safety nets are equally accountable for the increase and rise in mood disorders

Mindfulness is just 1 part of the eight-fold path which leads to the cessation of suffering – there are 7 additional parts that are also necessary – mindfulness alone will not suffice.

Mindfulness is seeing things as they are. It’s dropping all pretense and delusion. It’s embracing that life as we know if is continual suffering and recognizing the causes of that suffering. It’s only once you’ve reached this point that suffering lets go.

“That, in the end, was what cured both my “conditions” and my daughter’s. We recognized that we had a seething cancer of anger deeply buried in our minds. Anger we had never been permitted to express, and when we did express it were told our anger wasn’t acceptable as a response.”

Well, this just goes to show that there is a lot of human variability. I know several angry people who have been angry their entire lives, and are very well aware that they are angry, and express it appropriately rather than bottling it up, and they are still deeply depressed. Of course, if they were lacking in self awareness in the way you say you were, they might be even more depressed. But to be honest, it seems to me that they would be happier if they were not so well aware of their anger. But good that it worked for you.

Seems it’s very popular among college students, software engineers, etc. People who need to concentrate. I think that if you need to concentrate to the extent that you need to be on drugs long term, you might want to rethink what you’re doing.

I get depressed over things that happen & are bad luck contributing to insecurity & the inability to give to the people I care about physically & spiritually things, tools, & time.
I didn’t understand clinical depression until I lived with someone who became depressed for no discernible reason.
My joke about Prozac: “It doesn’t bother me, why’s it bother you?”
Bob Dylan had a line about happiness as a yuppie idea. The idea being we aren’t ever going to be happy all of the time.
“So it goes.”
There are people who will not be happy enough no matter what, and they are different from those of us who become unhappy for reasons.
Fate happens to you. Destiny you grasp.
Knowing yourself & what it is you were meant to do be it warrior or doctor make all the difference.
What we love will become work in the end of it, & doing work we love is better than not.
I recommend hobbies for those who have to get their daily bread from the grind.
P.S. there is another Scott I saw.

When I was a kid growing up in L.A. it was pretty common for intersections to have 2 or 3 gas stations on the 4 corners, and now that i’m all grown up, chain drug stores pushing pills have replaced many of those gas stations, and we seem even more depressed as a people, in spite of ingesting a myriad of remedies.

1) Flavin Mononeucliotide (More so if you also have migraines but not if you have ulcerative colitis)
2) Anything that acts as a Calcium Channel Blocker (Magnesium, P5P) and low calcium diet
3) If you have insomnia as well try sleeping with your head at least a foot from the wall.
4) Valerian Root

SSRIs might increase you anxiety a lot before they reduce it. You might need an SNRI instead.

I’m coming into the discussion a little late; had to wait until the first cup of coffee kicked in.

“Is Everything You Think You Know About Depression Wrong?” depends on what you “think” you know. “Why Everything You Know About Depression Is Wrong” arrogantly assumes you are wrong, regardless of who you are and what you know.

I could argue that my experience with lifelong depression and nearly 30 years of research are every bit as valid as Johann Hari’s. I have a family history of depression that includes an older sister who was in therapy for years, refused to try antidepressants (she was afraid they would change her personality), and ended up committing suicide.

I just didn’t write a book about it, and it probably wouldn’t sell very well if I did, as it doesn’t fit into any of the popular narratives, e.g., the Big Bad Pharma drug pushers; how I cured my depression with a rare Amazonian herb (vitamin D, zinc supplements); how I cured my depression by eliminating sugar, caffeine, dairy products; how I cured my depression with positive thinking, forgiving my parents, finding Jesus, meditating just five minutes a day, taking control of my life, and on and on. It gets exasperating.

Anyone who claims they have all the answers to depression or that they know more about it than anyone else is automatically suspect. This is all the more true in Hari’s case; in just a short excerpt from his book, he makes an inexcusable error, evidently to substantiate the malevolence of the mental health industry. Dean Burnett touches on it in his article challenging Hari’s arguments.

At issue is Hari’s claim that the absence of the bereavement exclusion in the latest iteration of the DSM means that “if your baby dies at 10am, your doctor can diagnose you with a mental illness at 10.01am and start drugging you straight away.” In short, the bereavement exclusion was “removed,” because it was replaced with new guidelines for differentiating between major depressive disorder and the normal consequences of bereavement. The additional criteria were added specifically so that bereavement would not be diagnosed as mental illness and medicated, while a patient with underlying depression would be recognized as more vulnerable to severe depression in the face of life stressors, which could have dire consequences if left untreated. The new criteria are precise, and in my experience with both bereavement and depression, correct.

The urge to cherry pick data to suit one’s beliefs seems to be universal, and there’s something for everyone. Those who want to prove the greedy profiteering of the drug companies have ample evidence – and I could certainly add some appalling firsthand examples. There is ample evidence that SSRIs stop working after a few months. Again, I can confirm that. If you want to believe that antidepressants turn you into a zombie, I can add to that, too.

I also can confirm that, in the few months that the SSRIs worked, they saved my life. Moreover, it was not sold to me as a happy pill, but as a temporary means to get me back on my feet so that I could begin confronting a host of problems, including a serious alcohol addiction and a miserable relationship. As the saying goes, you can’t pull yourself up by the bootstraps if you can’t find your boots.

In all, I’ve had three bouts of severe depression, on top of the lifelong “low-level” depression known as dysthymia. I’ve been on just about every non-MAOI antidepressant on the market. Not once was I ever led to believe they would make me happier or cure all my problems. In some instances, I was given the prescription on the condition that I entered therapy. In most of the places I lived, there were community mental health clinics that provided care on a sliding-scale fee, so I was able to afford it. That’s not to say that I didn’t have to give up some other expenses, but it was a matter of priorities: What was more important, my mental health or having “stuff?”

I’m now in the VA healthcare system and have been on the same treatment plan for five years, which includes an antidepressant not in the SSRI class and not the “drug of choice” for my profile. Fortunately, I had a gifted and independent-thinking psychiatrist who was willing to work with me. It took two years to find the right combination, during which she allowed me some leeway to experiment. She also arranged for me to have in-community therapy through the VA Choice program.

Ironically, the VA – at least in the two regions with which I’ve had experience – doesn’t automatically push antidepressants, and it has tight controls on dextroamphetamine (Adderall), methylphenidate (Ritalin), and opioids. If it “pushes” anything, it’s cognitive therapy, the latest being Acceptance and Commitment Therapy (ACT). In the little bit of experience I’ve had with it, I’m not a big fan, but apparently it works for some people. In fact, among the anecdotes in early literature on ACT is its success in curing a man who was isolated and depressed due to social anxiety.

I’ve said many times that depression is still a taboo subject. One could argue that books like Hari’s can do more harm than good, in that they shame those who need antidepressants. Among the implications are that people on antidepressants are somehow lazy – they’d rather take a pill than make difficult lifestyle changes – or they are misinformed, misguided, gullible, disempowered, [fill in the blank].

There were several good comments on Hari’s article in last Monday’s links and Water Cooler, one of which included a link to a well-reasoned, more-complicated view of antidepressants, by Bay Area psychiatrist Scott Alexander (link provided by Craig H.). Speaking for myself, it was an effective antidote to Hari.

Good post. Not inconsistent with a lot of the points I made above. I think a key point is INTERACTIONS – we have genes, upbringing and experiences. Interactions between these are the key to depression and anxiety – thus a truly horrific genetic history of suicide and attempted suicide on one side of my family is accompanied by a huge history of anxiety disorders on the other. Neither radically affected my life (despite a psychiatrist explaining that my upbringing – experience – was far from ideal) until the third factor, experiences went pear-shaped.

You note you’ve never-tried an MAOI and that the SSRI was a short-term “pick-me-up” – the latter may well be true but increasing numbers of psychopharmacologists believe a placebo would be a “pick-me-up” just as well (since SSRIs DON’T work as they were advertised to). ONLY MAOIs and some tricyclics actually act in the way the clinical research predicted them to. FYI I went through the gamut of SSRIs/SNRIs/Tricyclics with no sustained success until I went onto an MAOI – “the mother of all anti-depressants” as my UK psychiatrists called it. For those of us who *DO* have some underlying chemical problem which, in the absence of an ability to “cure” adverse experiences etc, require a drug, then an MAOI is the ultimate long-term treatment. And as for the notorious “cheese effect”? Rubbish. Go search Medline. There are three broad groups of food I am supposedly meant to avoid (as they’ll cause an instant MI or stroke): cheese, fermented/cured products, and soy. As legions of patients have reported, the restrictions are far too severe. You typically are sensitive to ONE of the three groups – in my case soy. I eat pizza to my heart’s content, as well as various fermented/cured products.

Also, the side effects of SSRIs/SNRIs are radically misunderstood by General Practitioners (who typically prescribe them). The “suicide risk” is real among those with anxiety. Do you want to know how to get to the top of Sydney Harbour Bridge undetected? I can tell you. Yes it was that close.

Finally, I am disgusted by my home discipline, health economics. My MAOI has been off patent for 50+ years but costs the UK NHS £1,000+ per month. Why? Because no generic suppliers can be bothered to enter the market to compete the price down to the £10 it should be. Why? Because two generations of doctors have been taught plain incorrect stuff about anti-depressants and because a small profit multiplied by a significant proportion of the population is worth more than a small (typically elderly and therefore dying off) group who are on an MAOI. Rawls proposed the famous “veil of ignorance” to get people to imagine living in the shoes of someone in an awful situation – as far as I’m concerned most health economists have NEVER considered this and conspire to continue vile practices in mental health…..which is why none of my friends these days are health economists.

I was referred to a psychiatrist, who, as it happened, was about to leave on a two-week vacation. My mental state was serious enough that it couldn’t wait; I didn’t need just a little “pick-me-up” (presumptuous and condescending remark). We scheduled her first available appointment, and in the interim, she recommended seeing a GP in her network to evaluate my condition and write a prescription, if he thought it was necessary. They usually tell you, “Come back in two weeks,” anyway.

The following account does reinforce your observation, shared by others above, about the dangers of GPs prescribing antidepressants. He put me on the low-end dose of Prozac, with no instructions for ramping up. Even the starter dose needed to be titrated, particularly for someone who had never taken antidepressants.

I don’t recall how long it took, maybe two or three days, for the first noticeable effect. For me, that is and always has been a blinding headache lasting up to three days. As the headache subsided, my head totally emptied, and my muscles wouldn’t work. I lay on the couch for four or five days, staring at the ceiling. I didn’t think it was possible to be free of nearly all thought for that long.

Once that phase was over, I started getting agitated. This is the dangerous phase, because physical energy starts to return, mood isn’t yet stabilized, and there can be a strange lack of inhibition, thus the high risk of suicide. Different people experience it differently. My partner was out of town on a business trip, which in hindsight might have been a blessing, but I was alone and scared. I stopped taking the pills and waited for my appointment with the psychiatrist.

I told her about the bad reaction and said I didn’t think antidepressants were a good idea. She said the reaction was due to the dose and was surprised the doctor not only prescribed that much to start but didn’t provide any monitoring or emergency plan. She suggested starting over and ramping up properly, with adequate supervision. My first appointment with her was going well. I liked her and trusted her, so I agreed to try again.

Over the next several weeks, my energy level came back up, and I was functional for the first time in nearly three months. On the downward spiral, I’d tried to hang on by going for bike rides and, when that got too difficult, walking. Either way, the return trip required going up a steep hill. I had been biking for years, even rode in a few centuries, but no matter how much I trained, I always ended up walking the bike uphill. IIRC, it was about five or six weeks into the drug treatment when I made it all the way up that hill without getting out of the saddle.

At the time, I lived on the ocean side of the coastal range in California, which meant driving over a mountain pass to get to the Bay Area. The climb was something like 1200 feet in seven miles of twisting two-lane, and it wasn’t unusual for traffic to move at 65 mph. Never a confident driver, I was terrified of that road, to the point that I turned down temp jobs in the South Bay. I won’t say the Prozac made me fearless, but I could make it over the hill without white knuckles. Eventually, I started to enjoy it a little. That feeling continued, even after I went off the medication nine or ten months later.

That was all in addition to being able to make some difficult changes, including leaving the relationship, living alone for the first time in more than ten years, and getting serious about losing weight.

I had a brief experience with depression that caused me to cry at the least little thing that happened around me. It lasted about 3 years. I spent a lot of time in bed feeling sorry for myself. I went to a doctor and explained what I was experiencing and she gave me an anti-depressant. I quit taking it because of its side effects–it caused constipation. So I decided the cure was worse than the disease. But I also decided not to dwell on the reasons for the depression (it was based on my relationship that I was not willing to give up) and have gradually gotten control over the important aspects of my own life. The things that helped: walking about 7 km a day, becoming financially independent and saving for retirement, recognizing that I am not always right, occasionally “running away from home” for brief periods of time, becoming educated by obtaining a couple of degrees, seriously learning how to paint and doing so for ten years, etc. An even better antidote was thinking more of others after I had taken care of my own immediate concerns.

The good news is mental health is no longer hiding in the family hall closet of shame. Continuing open dialogue by demanding care/cure will advance brain research because everyone knows someone such as a family member, or a friend or acquaintance, friend of a friend, or firsthand who’s living with these brain/mood disorders.

In November 2004, my son had his first break and hospitalization. He was 21yrs. old which is the typical onset age for males to present. Eventually he was diagnosed with schizoaffective/bipolar/psychosis. He’s been through the litany of medications- particularly the newest anti-psychotics with awful side-effect from weight gain to relentless akathisia plus long term concerns. Lithium is still the best med out there but with a list of long term toxic side-effects. Today, his meds cocktail doesn’t fully relieve him from his disorder but with the combo of CBT- cognitive behavioral therapy and drugs, he’s able to function. Otherwise, he’d not be here today.

Believe me, I’m not pro-pharmaceutical with its stranglehold on drugs and chronic illness management. Unfortunately in the USA, pharma subsidizes most clinical studies at university hospitals and research labs. In fact, I’ve noticed over the past 12 years, the older he becomes the more he stabilizes. Imo, male hormone levels decrease with age and the disorder becomes manageable. However, November through March will always be difficult due to shortened days and less sunlight. I agree functioning isn’t good enough but for now, brain research is in its infancy. However, not taking his meds isn’t the answer, rather fine-tuning his meds cocktail does improve cognition into his 30’s. Brain disorders are not the same for everyone such as depression or schizoaffective, there’s a range from non-functional to highly functional.

From the literature I’ve read, chronic brain disorders like other illnesses can go into remission but can also reactivate. His older cousin was diagnosed with depression at 14. Patrick was an academic genius including a PhD working on his medical residency when he passed 2 years ago. He’d go off and on his meds while not informing those closest to him. Unfortunately, he was off the meds for 2 months prior to taking his life. His mother- a nurse, who has a similar illness to my son was also a proponent of off/on prescription management. Since her son’s death, she’s reconsidered self-management. I truly wish all the best in your journey of wellness.

rps, I have a neighbor whose 20 y.o. son is presently hospitalized. His mom is convinced it is OCD, since he has had OCD symptoms since he was little. But I am pretty sure he is going to end up with the same diagnosis as your son. She herself is bipolar (she didn’t tell me; someone who knows her husband told me). She’s comfortable talking about her son’s problem (while only alluding to her own) with me because of my own family experiences with depression and OCD. Also the fact that I don’t have kids may help; it removes a particular dynamic. Anyway, I just keep telling her that meds will probably be the answer, and that getting them as close to just right is the thing, from what I see. Your son’s experience helps confirm that for me. One issue for her is that her bipolar disorder makes her perception of his case kind of skewed. She goes from being convinced that he is doing wonderfully, to being so depressed that I don’t see her at all. Her other, younger son is not in such great shape either; he is very depressed, understandably. Anyway, I wish I could think of a way to be helpful to her.

I feel for your neighbor. Its a challenging life long disorder. 20’s are the rough years with a higher incidence of suicide, medication side-effects, and hospitalizations which is another hurdle with voluntary and involuntary commitment. Even then there’s no guarantees. There’s good days and then there’s those other days when he’s going through hell and clinging to me like a life raft while I’m doing my best maintaining my own sanity and autonomy. Thankfully, we’ve survived his 20’s and now into his 30’s.

The good news is the fortunate ones will eventually adjust with family support, a psychiatrist, clinical therapy, social worker or advocate, support group/friends, medication compliance and finally, actively participating in their health management and wellness.

The bad news is many families cannot handle this disruptive disorder, trauma and radical change in their adult sons and daughters, brothers and sisters, etc.. Many of them become disconnected to their families. Its a difficult disorder especially with a healthcare system dependent on state and federal dollars slashed for more tax breaks for the wealthy. Mental health programs and clinics are always in a state of jeopardy since their patients have the weakest voice living on the lowest rung of the welfare ladder.

Helping our family, friends and neighbor begins with creating a safe place allowing them to share their story without stigmatization. Simply, this safe place is an empathetic supportive listener.

rps, I’m sorry to read about what you and your son are going through. When life is that much of a struggle, dealing with day-to-day affairs like standing in line at the DMV, calling a plumber before the leak under the sink turns into a flood, or just getting to work can seem daunting. You are right that we need to open up and talk about these things without feeling judged.

Thank you for also sharing your journey as well as Yves for supporting this forum. I must say my son is the brave one who openly shared his diagnosis early on. He encouraged our family to share his information knowing being tagged mentally ill is entrenched with societal stigmatization and marginalization. Diagnosis is a long process and a good psychiatrist will interview parents and siblings seeking genetic and environmental background. Extended family members eventually opened up about their diagnoses. And believe me, we asked both sides of the family while psychiatrists worked on identifying his disorder. Silence in this case is not the golden rule.

Its difficult to change the conversation about mental health if people hide in their dark closets fearing the leprosy of shame and stigmatization. Genetics is a roll of the dice and we don’t get to choose cancer any more than alzheimers, heart or thyroid disease, or brain disorders. Mental health disorders are not contagious and just snap out of it isn’t an effective remedy but a wish to make it disappear by the people who have been indoctrinated to fear the mentally ill.

Since my son’s diagnosis, I cannot count the number of people who’ve come forward and shared their mental health stories. Because of my son, we’ve supported family, friends and acquaintances in early intervention and navigating the convoluted mental healthcare system.

Never dealt with psychotropic medications myself and only got exposed to them recently via a family member, but was absolutely horrified by the experience.

Some simple advice: It’s probably ok to take them for up to three months on a GPs prescription, but if you are going to take them for more than three months you should do everything you can to have your prescription managed by a psychiatrist. Granted there’s no guarantee that a psychiatrist will do a good job, but at a minimum the psychiatrist will have a lot of experience with the various medications and can hope to have a reasonable understanding of your response to them. In my experience GPs are simply not qualified to handle long-term psychotropic medication prescriptions.

Hari mentions the work of Dr. David Healy. I haven’t read all the comments, so perhaps attention has already been drawn to Healy’s important book on potential dangers of anti-depressants and the ways of Big Pharma, Let The Eat Prozac, published 2003 by Lorimer. Highly recommended. Healy was subjected to disgraceful treatment at the University of Toronto following a talk he gave describing his research findings. The case is described in documents available at: https://www.pharmapolitics.com/

“The David Healy Affair
There has been international media coverage of the events surrounding the University of Toronto’s withdrawal of a formal job offer to the psychiatrist David Healy. Interest has been aroused because of the suggestion that the job withdrawal was a consequence of the clash of interest between academic freedom and the commercial interests of pharmaceutical companies. Indeed, these specific events have raised much more general concerns about the possible influence of large corporations on intellectual debate in Western democracies.
In view of the potential importance of this affair, this web site makes available some of the primary source documentation :- Dr Healy’s lecture in Toronto which immediately preceded the withdrawal of the job offer, transcripts of e-mail correspondence following the talk, and the transcript of a Canadian Broadcasting Corporation documentary on the topic.”

I was recently prescribed lamotrigine (Lamicil) for petit mal epileptic episodes. I don’t think anyone suggests epilepsy has psychological causes as opposed to a chemical disorder in the brain.

As the lamotrigine kicked in my epileptic episodes ceased entirely and I also noticed that both my chronic depression and GAD episodes improved majorly. Researching the point I discovered that lamotrigine (which is not an SSRI) is being increasingly prescribed off-label for both conditions.

Hence in my case anyway I’m confident that both my depression and GAD were, like my epilepsy, based on chemical malfunctions in my brain rather than my having an inadequate circle of friends or my not having dedicated my life to finding a cure for cancer but, hey, what do I know? Apart from what works for me.

vis a vis the Millennial mantra, “meaningful work,” somebody forgot to mention to these folks that you make your own meaningful work! Productive activity is not meaningful in and of itself. No free lunch here [or anywhere else].

I have been taking some combination of SSRIs for over 30 years, and although it’s not perfect, it’s the only way I can be a functioning member of society. While there may be a depression industry that is using marketing etc to profitably push medication as unhealthy coping mechanisms for shortcomings of modern society, let’s not overlook that there are real genetic conditions that require help. An uncomfortable number of my mother’s family died in “sanitariums” and under quack medical care because the chemical aid they needed was not available.

Speaking about anecdotal information, my personal experience with SSRI’s is that they work for me. After suffering periodic bouts of depression for several decades, I finally decided to look into trying out SSRIs. With the help of my PCP, I found an SSRI and a dosage that has worked for me for over 20 years. I tried weaning myself off the SSRI under doctor’s supervision, and I had another period of depression. After that, I admitted that I’d better just stay on the dose I have been taking that was successful in preventing further episodes of depression.

You can tell me it is just a placebo, and you may be right, but it is a placebo that works for me.

I have always had minor depression, which I choose to treat with vigorous exercise. It works real well for me.
In the mid 1990’s a new GP I was seeing asked me about depression and upon receiving an affirmative answer decided to put me on Prozac.
That drug completely changed my personality. I became a risk taker and began to drink alcohol everyday. Prior to taking Prozac I drank approx. 3 alcoholic drinks per year. I was also uncharacteristically unfaithful to my husband during that time.
After 9 months I took myself off of that drug and my personality returned to normal.
It was truly the most harrowing and inexplicable period in all of my 60 years.
To this day I get a physical reaction like hair standing on end when I even hear the word “Prozac.”
SSRI’s may be of some benefit to a very small subset of those who suffer from depression but they can also be horrible as I know personally.
Unless you’re really thinking of self-harm those who have depression should think twice before letting your doctor put you on any meds for the condition.
Exercise and activities that take you “out of yourself” are the best meds for me.
Thanks so much for printing this post today, Yves.

Robert Whitaker has written about the mistreatment of psychotropic drug therapy for a full range of drugs, including depression. He runs a website,
Mad in America which includes posts by mental health professionals. Most commentators on this string would find Mad in America dealing with the same issues raised in this post and I’m surprised no one has mentioned it.
Whitaker has written several books. Here is the one most relevant to today’s discussion: Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America
by Robert Whitaker

For what it’s worth, I was developing disparate health issues and felt like I was falling apart. I had a vague idea it was food related so on the recommendation of a friend, I tried an elimination diet. Within 3 days of giving up gluten, I had significant improvements. It’s been a little over 10 years now. One of the things that improved was lifelong anxiety and depression went away. Prior to going gluten-free, at various times I had taken Immipramine, Klonopin, Zoloft, Prozac, Valium, and some other meds I have now forgotten. None of my doctors had ever suggested my anxiety and depression might be linked to food.

Gluten causes inflammation in people like myself so I do think there’s a connection there.

As a person diagnosed with depression and a user of these antidepressants, I have to agree with this article. I have been thinking for a while about the structure of society causing mental illnesses ever since I read about how societial inequality is linked with greater incidences of mental illness.

This is thoroughly linked with my life experiences. Struggling to survive near the bottom of the barrel isn’t a great feeling and antidepressants help me to carry on. I also have mental disorders on top of that and anything that makes you stand out in a “negative” way really does impact your quality of life in navigating through American society that places great emphasis on great sociability and normalcy.

I don’t doubt there can be malicious intent behind the over-prescription, but another angle I view is what else can the mental health industry do in this situation if they had benetifical intent? They can’t just go out and reform society for the better. Sure they can prescribe less when they aren’t needed, but pills will have to be used at some point to make people not feel miserable. I suppose advocacy would be better than nothing but I fear the powerful influence of a powerful person’s paycheck being threatened.